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Challenges and burden of the Coronavirus (COVID-19) pandemic.

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INTRODUCTION

As health systems throughout the world struggle to respond to the coronavirus disease pandemic of 2019 (COVID-19), the crisis has thrown many key global environmental health concerns into sharp light. It’s becoming evident that environmental and climate variables have a role in shaping the landscape in which COVID-19 spreads across the world, affecting public health responses and interfering with existing environmental health inequalities. Coronavirus (COVID-19) is wreaking havoc on people all over the world. Isolation, contact limitations, and economic closure has all had a significant impact on the psychological environment of the countries impacted. These policies have the potential to seriously jeopardize the mental health of children and adolescents. Despite the fact that the current crisis may provide possibilities for personal growth and family togetherness, the drawbacks may exceed these advantages. The primary issues are anxiety, a lack of peer contact, and fewer possibilities for stress control. A higher likelihood of parental mental illness, marital violence, and child maltreatment is another major danger. This may be a particularly difficult period for children and adolescents with specific needs or disadvantages, such as impairments, trauma experiences, pre-existing mental health problems, migratory origin, or poor socioeconomic position. Maintaining regular and emergency child and adolescent psychiatric care throughout the pandemic is a huge challenge, but it is essential for reducing the long-term effects on children’s and adolescents’ mental health.

CHALLENGES IN TERMS OF SOCIETY AND CULTURE[1]

India’s social fabric depends on the emotional and economic connection among families, relatives, and friends. Close physical contacts, such as living in crowded dwellings and other locations, pushing and jostling, are highly prevalent and function as a barrier to the imposed ‘social distance’ during this epidemic. Despite the lockdown, crowding has been reported in religious establishments, during transit (e.g., ‘herds’ of migrants on buses), and even when purchasing alcohol in shops. While disparities in India are caused by ‘vertical distance,’ the ‘horizontal distancing’ implemented in the aftermath of COVID-19 has worsened them.

The most concerning element is the lack of adequate safety nets (e.g., food safety) for those who are most affected by lockdown. The government’s plans are woefully insufficient in light of the problem’s enormity. The lockdown has raised the risk of malnutrition for those of poor socioeconomic status. As part of the government of India’s fight against COVID19, the Food Corporation of India recently distributed 12.96 lakh metric tonnes of food grains under the Pradhan Mantri Garib Kalyan Anna Yojna (PMGKAY). The scheme’s efficacy and the adequacy of food distribution have to be seen.

CHALLENGES WITHIN THE FAMILY

The pandemic has caused a reorganization of daily life at the household level. All members of the family must deal with the stress of quarantine and social isolation. School closures have resulted in home-schooling and the possible delay of examinations. Parents have been under growing pressure to work from home, maintain careers and companies, and care for educating children at home at the same time, while caregiver resources, such as grandparents and extended family, have been limited. Family ties and assistance may be jeopardized. The fear of losing family members who are members of a high-risk group might grow. In the event of death, the pandemic affects families’ usual grieving rituals. Grief and grieving for lost family members, particularly when contact with the infected person is limited or denied, can lead to adjustment issues, post-traumatic stress disorder, depression, and even suicide in both adults and children.

Parents are also responsible for informing and explaining the COVID-19 epidemic to their children, as well as dealing with the worry and anxiety that comes with these uncertain times. COVID-19 may cause anxiety in every member of the family. When all of this happens at once, it can cause a lot of stress and psychological discomfort for everyone in the family. The pandemic has significant economic consequences and places financial strain on many households. Economic strain, especially if not accompanied by social isolation, has been demonstrated to represent a serious danger to mental health in prior economic downturns. To begin with, economic recessions and related factors such as unemployment, income decline, and unmanageable debts have been linked to a decline in mental well-being, increased rates of several mental disorders, substance-related disorders, and suicidal behaviors risks that parents understandably, are concerned about.

CHILD ABUSE AND DOMESTIC VIOLENCE[2]

In particular, during economic downturns, there is a substantial rise in domestic violence. Loss of income and financial difficulty can contribute to emotions of financial stress and, as a result, marital conflict. The quarantine can lead to a loss of independence and privacy, as well as increased stress. It may also exacerbate abusers’ current controlling tendencies as they try to reclaim control. Victims are more likely to be exposed to abusers, and their chances of temporarily escaping abusive spouses are diminished. There have been reports from all around the world regarding a substantial rise in domestic violence during the present COVID-19 issue. Furthermore, throughout the recession, there was a noticeable increase in physical, emotional, and sexualized violence against children. In the literature, a rise in all types of child maltreatment has been documented in a number of cultures during a recession. Based on these findings, a global rise in the hazards for children and adolescents is a reasonable expectation for the COVID-19 pandemic.

COVID19-related morbidity and death in India are primarily owing to comorbid illnesses such as diabetes, hypertension, and cardiovascular disease. Furthermore, the early start of NCDs, which is frequent in India, puts even younger people at risk for COVID-19. COVID19 has the potential to disrupt India’s health and healthcare systems in a variety of ways. Because of low physical activity, increased snacking, and intake of calorie-dense foods, the lockdown might potentially be a cause of weight gain during the COVID19 pandemic. In observational research done by our group, carbohydrate consumption and snacking frequency rose by 21% and 23%, respectively, while exercise duration was reduced in 42% of patients and weight gain was seen in 19% of type 2 diabetes patients. Obesity and weight gain may exacerbate COVID-19 and increase the chance of developing diabetes and cardiovascular disease in the future. Other illnesses, some of which had exhibited a promising trend in their control until recently, might also be on the rise. Infection with the Human Immunodeficiency Virus (HIV), tuberculosis (TB), and malaria-related mortality, for example, may rise by 10%, 20%, and 36% over 5 years, respectively, compared to a scenario without the COVID-19 pandemic. There are a variety of causes for this, including the discontinuation of antiretroviral medication (ART), delays in diagnosing and treating tuberculosis (TB), and decreased preventive measures, including the cancellation of malaria net programs.

CONCLUSION

There are various mental health risks linked with the present epidemic and the restrictions that have resulted as a result of it. Psychiatrists for children and adolescents must maintain continuity of care throughout the epidemic. The mental health concerns linked with COVID-19 will disproportionately affect children and adolescents who are already poor and disenfranchised. In order to be better prepared for future developments, research is needed to examine the consequences of policies adopted to control the pandemic on the mental health of children and adolescents, as well as to quantify the risk/benefit ratio of interventions such as homeschooling. To avoid long-term negative health effects, the COVID19 pandemic has demanded a holistic approach to the disadvantaged and marginalized communities. Economic pressures on the entire population must be alleviated, and legislative reforms must be implemented quickly. Finally, national health programs for communicable diseases and noncommunicable diseases (NCDs) must be revitalized and improved.


[1] Hema S. Gopalana and Anoop Misra, Ncbi (May 30, 2020)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261093/#bib21

[2] Jörg M. Fegert, Benedetto Vitiello, Paul L. Plener & Vera Clemens.BMC( May 12.2020)

https://capmh.biomedcentral.com/articles/10.1186/s13034-020-00329-3

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